Provider Demographics
NPI:1316335334
Name:HYDRA HEALTH CENTERS
Entity type:Organization
Organization Name:HYDRA HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:818-749-4778
Mailing Address - Street 1:15332 ANTIOCH ST
Mailing Address - Street 2:SUITE: 820
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3628
Mailing Address - Country:US
Mailing Address - Phone:818-749-4778
Mailing Address - Fax:
Practice Address - Street 1:400 CONTINENTAL BLVD
Practice Address - Street 2:STE 600
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5076
Practice Address - Country:US
Practice Address - Phone:818-749-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty